NPIMap

Individual provider Active NPI

Mohamed Ruzaik Ibrahim, MD

  • Cardiovascular Disease Physician
  • Mount Vernon, IL
National Provider Identifier
1235309527
Registry record updated Jun 30, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
036128960 Issued in IL
Practice address
4115 S Water Tower PL
Mount Vernon, IL 62864-6293
Phone
(618) 315-6090
NPI assigned
Mar 3, 2008
Last updated
Jun 30, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X A98494 CA
Cardiovascular Disease Physician 207RC0000X 036128960 IL Primary

Addresses

Primary practice location

4115 S Water Tower PL
Mount Vernon, IL 62864-6293

Mailing address

4113 S Water Tower PL
Mount Vernon, IL 62864-6293
Phone (618) 315-6090

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220819002352 NY Practitioner - Cardiovascular Disease (Cardiology) 4082786942 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)
Education
University of California, Geffen School of Medicine, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Massena Hospital IncGroup PAC ID 1456781491, 45 clinicians
Canton-Potsdam HospitalGroup PAC ID 6204827280, 243 clinicians

Practice addresses (Care Compare)

1 Hospital Dr
Massena, NY 13662-1056

201 Market St
Suite E
Potsdam, NY 13676-1218
Phone (315) 274-9102

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
98.56 of 100Reported as apm
Quality
87.76
Promoting interoperability
100
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
98.56 of 100Reported as apm
Quality
87.76
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
98494CAMDClinical Social Worker
A98494CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Canton-Potsdam Hospital CurrentSince Aug 15, 2022 Accepting new patients
Canton-Potsdam Hospital CurrentSince Aug 15, 2022 Accepting new patients
Massena Hospital, Inc CurrentSince Aug 15, 2022 Accepting new patients
Massena Hospital Inc CurrentSince Aug 15, 2022 Accepting new patients
Southern Illinois Heart and Vascular Center, PC Cardiovascular Disease PastSince Jul 20, 2009 Accepting new patients
Canton Potsdam Hospital Past Accepting new patients

Locations

1 Hospital Dr
Massena, NY 13662
Phone (315) 764-1711

1 Hospital Dr
Fl 3
Massena, NY 13662
Phone (315) 769-1111

201 Market St
Ste E
Potsdam, NY 13676
Phone (315) 274-9102

50 Leroy St
Potsdam, NY 13676
Phone (315) 261-6034

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/JBDGCA
  • Direct secure messaging: mribrahi@yourcarecommunity.org
  • Direct secure messaging: ribrahim352016@direct.rochesterregional.org

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1204502400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1467244800000",
    "number": "1235309527",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4113 S WATER TOWER PL",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628646293",
            "telephone_number": "618-315-6090",
            "fax_number": "618-204-5472"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4115 S WATER TOWER PL",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628646293",
            "telephone_number": "618-315-6090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IBRAHIM",
        "first_name": "MOHAMED RUZAIK",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-03-03",
        "last_updated": "2016-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A98494",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "IL",
            "license": "036128960",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Vernon, IL

Sources for this page

Verify at the official NPI Registry.